These findings are nothing new. As far back as 1993, peer-reviewed studies documented that Medicaid patients incurred worse health outcomes in areas as diverse as childhood asthma; breast, cervix, colon, and lung cancers; myocardial infarctions; strokes; and pneumonia than do comparable patients with private insurance. Asked to explain why they refuse to see Medicaid patients, physicians pointed to the impenetrable government paperwork and bureaucratic obstacles they encounter as well as to Medicaid’s notoriously low reimbursement rates.
Medicaid’s crisis, moreover, has spread to the entire health sector. A 2012 national survey of nearly 14,000 physicians identified a “silent exodus of physicians from the workforce” driven by “significant changes to the medical practice environment,” including physicians’ frustration with the recent round of health reforms. “Physicians,” the researchers found, “are working fewer hours, seeing fewer patients and limiting access to their practices.” Within four years, the equivalent of over 44,000 physicians will leave the workforce, and more than half will “cut back on patients seen, work part-time, switch to concierge medicine, retire, or take other steps likely to reduce patient access.”
Governors and state lawmakers beware: This “silent exodus” of physicians comes at precisely the time when Obamacare will be asking states to add fuel to Medicaid’s raging fire. And the temptation to embark on this fiscally foolhardy path will be great. Obamacare’s architects are offering a generous — but temporary — 100 percent federal payment to cover the cost of the expansion, as well as federal coverage of a temporary increase in the fees primary-care doctors receive for seeing Medicaid patients. But, like the cherry blossoms that ring the Tidal Basin, these payments will quickly wither away, leaving it to the states — suffering from the fiscal straitjacket Medicaid already puts on their budgets — to assume the burgeoning costs of Obamacare’s Medicaid expansion.